Sleep Problems and Smoking Cessation in Women

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1 Sleep Problems and Smoking Cessation in Women Michele D. Levine, Michele L. Okun, Patricia R. Houck, Melissa A. Kalarchian & Marsha D. Marcus University of Pittsburgh Medical Center

2 Sleep and Smoking Cigarette smoking can negatively impact sleep quality Sleep disturbance, a symptom of nicotine withdrawal, can interfere with smoking cessation Sleep quality and daytime drowsiness may interfere with cessation or longer-term abstinence Nocturnal sleep-disturbing nicotine cravings have also been reported during smoking cessation

3 Sleep, Smoking and Women Women report more sleep disturbances than men More nocturnal disruptions Poorer sleep quality More symptoms of insomnia Women also have more difficulty quitting smoking than men Little is known about how self-reported sleep changes during a smoking cessation program

4 Aims Accordingly, we evaluated the relationship between sleep and cessation outcome among women enrolled in cessation treatment Specifically, we sought to: 1. Describe sleep among women in a smoking cessation program 2. Determine whether sleep disturbances at baseline or at 1 month predict smoking status at 3 months

5 Hypotheses 1. Subjective sleep complaints over the first three months would differ between women who did and did not maintain smoking abstinence 2. Sleep complaints prior to quitting and early in cessation would be associated with smoking at 3 months

6 Methods Women (N = 322) enrolled in a smoking cessation treatment study Assessments of smoking, sleep, nicotine withdrawal and depressive symptoms were completed at baseline and prior to each of 12 counseling sessions Sleep quality was assessed at baseline, week 4 and 3 month follow-up

7 Participant Characteristics (N=322) Age College Education % White Body Mass Index Cigarettes/Day Nicotine Dependence BDI* 41.9 (10.2) 34% 86% 27.4 (5.5) 20.6 (8.2) 5.2 (2.1) 6.9 (6.4) * Sleep question removed

8 Study Design

9 Treatment Counseling 12 sessions over a 10-week period TQD is week 3 Medication Start 1 week prior to quitting Continue medication for 24 weeks

10 Sleep Measures Sleep Disturbance: 1 item from the Beck Depression Inventory Dichotomized into no vs. any sleep disturbances Drowsiness and Insomnia: 2 items on visual analogue scale for withdrawal symptoms in the previous 24 hours Scores ranged from 0 ( not( at all ) ) to 100 ( severe ). Median = 30

11 Sleep Measures Sleep quality * 5 items from the Wisconsin Smoking Withdrawal Scale 1. I I am getting restful sleep 2. I I awaken from sleep frequently during the night 3. I I am satisfied with my sleep 4. I I feel that I am getting enough sleep 5. My sleep has been troubled Items were summed to create a composite ranging from 0-20, 0 with higher numbers reflecting better sleep quality *assessed at baseline, month 1 and 3 item reversed scored

12 Smoking Outcomes Abstinence: self-report of no smoking for 7 consecutive days and CO 8 Drop-outs outs were classified as having relapsed

13 Statistical analysis Repeated measures, mixed effect models to evaluate sleep over 3 months and by smoking status Regression analyses to evaluate whether sleep complaints at baseline, were associated with smoking status at 3 months, controlling for depressive symptoms Among women abstinent at 1 month, regression analyses to predict smoking status at 3 months from sleep complaints, controlling for baseline sleep complaints, and baseline depressive symptoms. All analyses controlled for treatment group

14 Results 42% of women reported sleep disturbances prior to quitting Participants also reported slight drowsiness (mean= 23.1) and insomnia (mean = 13.8) Women were moderately satisfied with sleep quality (mean = 11.9)

15 Results: Sleep Disturbance Sleep disturbance did not change over time and was not associated with smoking status

16 Results: Drowsiness and Insomnia Drowsiness (p<.0001) and insomnia (p<.0004) decreased significantly over time Women who were smoking at 3 months reported more drowsiness than did those who maintained abstinence, particularly during weeks 7-12

17 Drowsiness (30+) Percentage smoking at 3 months abstinent 3 months Week Time, p =.0001 Smoking status X Time, p =.02

18 Insomnia (30+) Percentage smoking at 3 months not smoking at 3 months Week Time, p =.0004

19 Results: Sleep quality Sleep quality tended to change over time decreasing through 1 month and improving at 3 months Sleep quality was not related to smoking status over time, although women who remained abstinent by 3 months reported better sleep quality at 3 months post-quit than women who relapsed

20 Sleep Quality Over Time smoking at 3 months abstinent at 3 months Time Time, p =.06

21 Results Sleep complaints prior to treatment were not associated with smoking status at 3 months Sleep complaints among women quit at 1 month were not associated with relapse at 3 months

22 Summary Subjective sleep complaints among smokers enrolled in cessation treatment vary over time Women who maintained abstinence at 3 months, reported less drowsiness between 1 and 3 months after quitting However, there were no differences in symptoms of insomnia, sleep disturbance, or quality of sleep between women who remained abstinent and those who relapsed Contrary to our hypothesis, sleep complaints were not related to treatment outcome

23 Comment There is modest support that drowsiness may be important in understanding smoking cessation treatment outcome However, subjective sleep complaints may be a correlate of nicotine withdrawal and may not be uniquely related to cessation outcome Future work using validated measures of sleep complaints as well as objective sleep assessments may help further elucidate the relationship among smoking, sleep complaints and treatment outcome

Declaration of Conflict of Interest. No potential conflict of interest to disclose with regard to the topics of this presentations.

Declaration of Conflict of Interest No potential conflict of interest to disclose with regard to the topics of this presentations. Clinical implications of smoking relapse after acute ischemic stroke Furio